Polyhydramnios and

olygohydramnios
DR. dr. Rizani Amran, SpOG(K)

Normally:
Amnionic fluid volume increases

to about 1 lit or more by 36 wks

In postterm there may by only

100-200ml

Normal volumes of amniotic fluid

varies with the duration of pregnancy
Average of amniotic fluid volume

12 w: 50 ml
24 w: 500 ml

36 w: 1000 ml & decreases thereafter.

At term: The normal range in a singleton

pregnancy is large: 500-1500 ml

polyhydramnios

Definition
Amniotic fluid volume (AFV) >2 L

Incidence
1-4% pregnancies.

Types
1. Chronic:
Excess fluid accumulates gradually & it is only
noticed after the 30th w of pregnancy. It is 10
times more common than acute PH.

2. Acute:
Excess fluid accumulates more quickly & it
occurs earlier in pregnancy. It is usually
associated with twin pregnancy

With sonography:
Mild
Moderate

Sever

8-11cm
12-15cm
>16cm

80%
15%
5%

Causes
*Fetal:
1- Multiple pregnancy
2- Hydrops fetalis

3- Fetal anomalies

Fetal anomalies
Neural tube defect (Anencephaly , Spina bifida )
1- Increased transudation of CSF
2- Excessive urination
* stimulation of cerebrospinal centers

* impaired arginine vasopressin secretion

Duodenal atresia

Thoraco-oesophageal fistula

* Maternal:
Diabetes mellitus
Maternal hyperglycemia

Fetal hyperglycemia

Osmotic diuresis

Pre-eclampsia

Heart or renal failure

*Idiopathic

Symptoms
Dyspenea
Edema

Oliguria
Dyspepsia

Diagnosis
Uterine enlargment ( larger than

the period of pregnancy)

Difficulty in palpating fetal part
Difficulty in hearing fetal heart
Sonography

With sonography
A. Confirm diagnosis:
*Vertical pocket >8cm
*AFI >24 cm (AFI > 97.5 percentile for gestational age)

B. Detect the degree:

* mild
* Moderate
* severe

C. Detect the cause

Differential Diagnosis
1. Twins

2. Ovarian cyst
3. Full bladder

4. Hydatiform mole
5. Ascite

All are resolved by U/S

Complication
PROM
Prolapses of umblical cord
Placental abruption
Uterine dysfunction
Post partum hemorrhage

Pregnancy Outcome
In general, the more sever degree
of hydramnios
The higher perinatal mortality
rate

Managment
Minor degrees of hydramnios rarely
require treatment
Moderate degrees can usually managed
until labor ensues
Sever degrees ( dyspnea or abdominal
pain or other complication),
hospitalization become necessary

Treatment
Amniocentesis
500 ml/h
1500-2000 ml/d

Indometacin
Decreases lung liquid production
Decreases fetal urine production
Increases fluid movement across fetal
membranes

Oligohydramnios

Definition
Marked deficiency of the amniotic
fluid volume (below the normal limits)

incidence
0.5-5% of all pregnancies

In general:
Oligohydramnios developing early
in pregnancy is less common

and
Has a bad prognosis

Causes
Fetal
Chromosomal abnormalities
Congenital anomalies
Fetal death
IUGR
Postterm
PROM
Twin-twin transfusion

Maternal
uteroplacental insufficiency
Hypertension
Diabetes

Placenta
Abruption

Drug
Prostaglandin synthetase
inhibitors,
Angiotensin converting
enzyme inhibitors

idiopatic

Clinical picture
Uterus is small for date
Fetus:
easily felt & immobile
FHS easily heard

U/S:
Vertical pocket <1cm or <2cm;
AFI <5 cm

Complications
During

pregnancy

1. Fetal hypoxia (cord compression)

2. Persistent position of the fetus
3. Limb deformities: (pressure or amniotoic bands)
* talipes (clubfoot)

* ankylosis of joins

4. Pulmonary hypoplasia

During labor

Increased variable deceleration

Increased cesarean section rate

Treatment
Amnioinfusion:
infusion of saline into the uterine cavity
through the abdominal wall by a spinal
needle
To increase the AFV

To dilute meconium

Prognosis
Fetal outcome is poor with
early-onset oligohydramnios